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Analysis of failed surgery for patellar instability in children with open growth plates.
[trochlear dysplasia]
Many
surgical
procedures
have
been
proposed
to
treat
recurrent
patellar
dislocation
in
children
.
In
recent
years
,
a
more
tailored
approach
considering
the
underlying
pathology
has
been
advocated
.
The
aim
of
the
study
was
to
analyze
a
group
of
patients
with
recurrent
patellofemoral
instability
after
unsuccessful
operative
stabilization
(
Roux-
Goldthwait
procedure
,
lateral
release
,
medial
reefing
or
in
combination
)
in
childhood
and
adolescence
.
A
total
of
37
children
and
adolescents
with
recurrent
patellofemoral
instability
despite
previous
surgery
were
analyzed
retrospectively
.
Radiographic
examination
included
AP
and
lateral
views
to
assess
patella
alta
and
limb
alignment
.
MRI
was
performed
to
evaluate
trochlear
dysplasia
and
tibial
tubercle-trochlear
groove
(
TTTG
)
distance
.
As
a
control
group
,
23
age-
and
sex-matched
adolescents
that
were
treated
with
a
favorable
outcome
after
medial
reefing
alone
or
combined
with
a
Roux-
Goldthwait
procedure
were
analyzed
.
Severe
trochlear
dysplasia
(
type
B-D
according
to
Dejour
)
as
detected
on
MRI
scans
was
found
significantly
more
often
in
the
study
group
(
89
%
)
than
in
the
control
group
(
21
%
)
.
No
statistical
difference
of
patellar
height
ratio
(
Insall-
Salvati
index
)
and
TTTG
distance
between
the
two
groups
could
be
found
.
Of
the
measured
parameters
,
only
the
incidence
of
trochlear
dysplasia
was
increased
.
Trochlear
dysplasia
therefore
seems
to
be
a
major
risk
factor
for
failure
of
operative
stabilization
of
recurrent
patellofemoral
instability
in
children
and
adolescents
.
The
results
in
children
are
in
consensus
with
the
literature
in
adults
that
a
more
tailored
operative
therapy
including
reconstruction
of
the
MPFL
and
trochleaplasty
has
to
be
considered
.
Retrospective
study
,
Level
III
.
Diseases
Validation
Diseases presenting
"adolescents"
symptom
congenital adrenal hyperplasia
familial hypocalciuric hypercalcemia
hirschsprung disease
trochlear dysplasia
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